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Company

Adaptive Biotechnologies Corp. · 12 hours ago

Senior Appeals Specialist

United States

Full-time

Remote

Senior Level

$79K/yr - $119K/yr

5+ years exp

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Responsibilities

Develop and implement an appeals strategy that reduces denial rates and improves reimbursement outcomes.

Conduct thorough root-cause analysis of denied claims, identifying patterns and developing strategies to address systemic issues.

Create, maintain, and optimize appeal templates, documentation standards, and workflows to streamline the appeals process.

Work cross-functionally with billing, prior authorization, and insurance verification teams to coordinate efforts and enhance appeals effectiveness.

Monitor regulatory changes and payer policies, ensuring appeal practices remain compliant and adjusting strategies as needed.

Track, analyze, and report on appeal outcomes, providing insights to management to support continuous improvement in reimbursement processes.

Establish key performance indicators (KPIs) for appeal effectiveness and develop data-driven recommendations for ongoing optimization.

Serve as the subject matter expert on appeal processes, providing guidance, training, and support to reimbursement operations staff.

Collaborate with IT and analytics teams to develop tools and dashboards that facilitate tracking and reporting on appeal metrics.

In coordination with the Payor Relations team engage with payers, as necessary, to resolve high-priority appeals and maintain productive relationships that support favorable outcomes.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Healthcare reimbursementClaims appealsDenials managementMedical billingCodingICD-10CPTData analysisRevenue cycle managementHealthcare complianceTableauPower BICross-functional collaboration

Required

Bachelor’s degree + 5 years of experience in healthcare and/or life sciences

5+ years of experience in healthcare reimbursement, with a focus on claims appeals, denials management, or related areas.

In-depth knowledge of medical billing and coding standards, including ICD-10, CPT, and payer guidelines.

Demonstrated experience in developing appeal strategies or processes in a healthcare setting.

Strong analytical skills, with the ability to identify trends and develop actionable strategies based on data.

Excellent written and verbal communication skills for effectively communicating with internal stakeholders and payers.

Detail-oriented and highly organized, with a proactive approach to managing complex appeal cases.

Ability to work collaboratively in a cross-functional environment

Experience with revenue cycle management in a CLIA-certified laboratory or similar healthcare setting.

Familiarity with healthcare software solutions and data visualization tools, such as Tableau or Power BI.

Knowledge of payer policies, reimbursement regulations, and healthcare compliance standards.

Proven ability to work independently, manage multiple tasks, and prioritize in a fast-paced environment.

Benefits

Equity grant

Bonus eligible

Company

Adaptive Biotechnologies Corp.

Glassdoor

2.8

Adaptive Biotechnologies is a pioneer and leader in immune-driven medicine that aims to improve people’s lives by learning from the wisdom of their adaptive immune systems.

Founded in 2009

Seattle, Washington, USA

501-1,000 employees